Summary care record early adopter programme: an independent evaluation by University College London.

Benefits The main potential benefit of the SCR is considered to be in emergency and unscheduled care settings, especially for people who are unconscious, confused, unsure of their medical details, or unable to communicate effectively in English. Other benefits may include improved efficiency of care and avoidance of hospital admission, but it is too early for potential benefits to be verified or quantified. Progress As of end April 2008, the SCR of 153,188 patients in the first two Early Adopter sites (Bolton and Bury) had been created. A total of 614,052 patients in four Early Adopter sites had been sent a letter informing them of the programme and their choices for opting out of having a SCR. Staff attitudes and usage The evaluation found that many NHS staff in Early Adopter sites (which had been selected partly for their keenness to innovate in ICT) were enthusiastic about the SCR and keen to see it up and running, but a significant minority of GPs had chosen not to participate in the programme and others had deferred participation until data quality improvement work was completed. Whilst 80 per cent of patients interviewed were either positive about the idea of having a SCR or ?did not mind?, others were strongly opposed ?on principle?. Staff who had attempted to use the SCR when caring for patients felt that the current version was technically immature (describing it as ?clunky? and ?complicated?), and were looking forward to a more definitive version of the technology. A comparable technology (the Emergency Care Summary) introduced in Scotland two years ago is now working well, and over a million records have been accessed in emergency and out-of-hours care. Patient attitudes and awareness Having a SCR is optional (people may opt out if they wish, though fewer than one per cent of people in Early Adopter sites have done so) and technical security is said to be high via a system of password protection and strict access controls. Nevertheless, the evaluation showed that recent stories about data loss by government and NHS organisations had raised concerns amongst both staff and patients that human fallibility could potentially jeopardise the operational security of the system. Despite an extensive information programme to inform the public in Early Adopter sites about the SCR, many patients interviewed by the UCL team were not aware of the programme at all. This raises important questions about the ethics of an ?implied consent? model for creating the SCR. The evaluation recommended that the developers of the SCR should consider a model in which the patient is asked for ?consent to view? whenever a member of staff wishes to access their record. Not a single patient interviewed in the evaluation was confident that the SCR would be 100 per cent secure, but they were philosophical about the risks of security breaches. Typically, people said that the potential benefit of a doctor having access to key medical details in an emergency outweighed the small but real risk of data loss due to human or technical error. Even patients whose medical record contained potentially sensitive data such as mental health problems, HIV or drug use were often (though not always) keen to have a SCR and generally trusted NHS staff to treat sensitive data appropriately. However, they and many other NHS patients wanted to be able to control which staff members were allowed to access their record at the point of care. Some doctors, nurses and receptionists, it seems, are trusted to view a person?s SCR, whereas others are not, and this is a decision which patients would like to make in real time

The devil's in the detail: Final report of the independent evaluation of the Summary Care Record and HealthSpace programmes

professionals, NHS staff, service users, citizens, academics and evaluation scholars. It should be read in conjunction with our Year 1 reports on the SCR programme (May 2008) 1 and data quality (May 2008). 2 2. The SCR is an electronic summary of key health data, currently drawn from a patient’s GP-held electronic record and accessible over a secure Internet connection by authorised healthcare staff. It is one of a suite of innovations being introduced as part of the National Programme for IT in the English National Health Service (NHS) and delivered via a central ‘Spine’. Policy documents published in 2005-8 anticipated a number of benefits of the SCR, including: 3-6 a. Better care (i.e. the SCR would improve clinical decision-making); b. Safer care (i.e. the SCR would reduce risk of harm, especially medication errors); c. More efficient care (e.g. the SCR would make consultations quicker); d. More equitable care (i.e. the SCR would be particularly useful in patients unable to communicate or advocate for themselves); e. Reduction in onward referral (e.g. the SCR would avoid unnecessary ambulanc

Dyslipidemia impairs mitochondrial trafficking and function in sensory neurons

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154247/1/fsb2fj201700206r.pd

Unequal Mass Binary Black Hole Plunges and Gravitational Recoil

We present results from fully nonlinear simulations of unequal mass binary black holes plunging from close separations well inside the innermost stable circular orbit with mass ratios q = M_1/M_2 = {1,0.85,0.78,0.55,0.32}, or equivalently, with reduced mass parameters $\eta=M_1M_2/(M_1+M_2)^2 = {0.25, 0.248, 0.246, 0.229, 0.183}$. For each case, the initial binary orbital parameters are chosen from the Cook-Baumgarte equal-mass ISCO configuration. We show waveforms of the dominant l=2,3 modes and compute estimates of energy and angular momentum radiated. For the plunges from the close separations considered, we measure kick velocities from gravitational radiation recoil in the range 25-82 km/s. Due to the initial close separations our kick velocity estimates should be understood as a lower bound. The close configurations considered are also likely to contain significant eccentricities influencing the recoil velocity.Comment: 12 pages, 5 figures, to appear in "New Frontiers" special issue of CQ

Implementation of standard testbeds for numerical relativity

We discuss results that have been obtained from the implementation of the initial round of testbeds for numerical relativity which was proposed in the first paper of the Apples with Apples Alliance. We present benchmark results for various codes which provide templates for analyzing the testbeds and to draw conclusions about various features of the codes. This allows us to sharpen the initial test specifications, design a new test and add theoretical insight.Comment: Corrected versio

Superkicks in Hyperbolic Encounters of Binary Black Holes

Generic inspirals and mergers of binary black holes produce beamed emission of gravitational radiation that can lead to a gravitational recoil or kick of the final black hole. The kick velocity depends on the mass ratio and spins of the binary as well as on the dynamics of the binary configuration. Studies have focused so far on the most astrophysically relevant configuration of quasi-circular inspirals, for which kicks as large as 3,300 km/s have been found. We present the first study of gravitational recoil in hyperbolic encounters. Contrary to quasi-circular configurations, in which the beamed radiation tends to average during the inspiral, radiation from hyperbolic encounters is plunge dominated, resulting in an enhancement of preferential beaming. As a consequence, it is possible to achieve kick velocities as large as 10,000 km/s.Comment: 4 pages, 5 figures, 1 tabl

Stochastic Gravitational Wave Background from Coalescing Binary Black Holes

We estimate the stochastic gravitational wave (GW) background signal from the field population of coalescing binary stellar mass black holes (BHs) throughout the Universe. This study is motivated by recent observations of BH-Wolf-Rayet star systems and by new estimates in the metallicity abundances of star forming galaxies that imply BH-BH systems are more common than previously assumed. Using recent analytical results of the inspiral-merger-ringdown waveforms for coalescing binary BH systems, we estimate the resulting stochastic GW background signal. Assuming average quantities for the single source energy emissions, we explore the parameter space of chirp mass and local rate density required for detection by advanced and third generation interferometric GW detectors. For an average chirp mass of 8.7$M_{\odot}$, we find that detection through 3 years of cross-correlation by two advanced detectors will require a rate density, $r_0 \geq 0.5 \rm{Mpc}^{-3} \rm{Myr}^{-1}$. Combining data from multiple pairs of detectors can reduce this limit by up to 40%. Investigating the full parameter space we find that detection could be achieved at rates $r_0 \sim 0.1 \rm{Mpc}^{-3} \rm{Myr}^{-1}$ for populations of coalescing binary BH systems with average chirp masses of $\sim 15M_{\odot}$ which are predicted by recent studies of BH-Wolf-Rayet star systems. While this scenario is at the high end of theoretical estimates, cross-correlation of data by two Einstein Telescopes could detect this signal under the condition $r_0 \geq 10^{-3} \rm{Mpc}^{-3} \rm{Myr}^{-1}$. Such a signal could potentially mask a primordial GW background signal of dimensionless energy density, $\Omega_{\rm{GW}}\sim 10^{-10}$, around the (1--500) Hz frequency range.Comment: 22 pages, 5 figures, 2 tables, Accepted for publication by Ap

Gravitational perturbations of Schwarzschild spacetime at null infinity and the hyperboloidal initial value problem

We study gravitational perturbations of Schwarzschild spacetime by solving a hyperboloidal initial value problem for the Bardeen-Press equation. Compactification along hyperboloidal surfaces in a scri-fixing gauge allows us to have access to the gravitational waveform at null infinity in a general setup. We argue that this hyperboloidal approach leads to a more accurate and efficient calculation of the radiation signal than the common approach where a timelike outer boundary is introduced. The method can be generalized to study perturbations of Kerr spacetime using the Teukolsky equation.Comment: 14 pages, 9 figure